sir,
 
case 1
 
today we saw a thalassemia patient, 18 years old female..
she came for blood transfusion. she had spleenectomy scar, and palpable mass most probably a liver 3 finger breadth below the costal margin. she also had arachnodactyly, so we were thinking of existing marfan's syndrome.her arm span seem to be more than her height.but then homocysteinuria also have similar clinical picture. we dun know haw to assess the mental function to say whether she is mentally retarded or not as it is seen in homocysteinuria. we want to do further examination but then the hospital staff already came so we had to go. i come in the afternoon but she's not there anymore. so i couldnt complete my examination.
 
 
case 2..
 
29 year old female, she was admitted because, during her follow up she was found to have tachycardia and have fever. she has been diagnosed to have SLE one year back and was put on medication since then. she couldn't name her madication.
she also complaint of early morning proximal interphalangeal stiffneas which relieves after doing minor exercise of the hand.
there is no malar rashes (i couldnt see any discolouration of the cheek), respiratory and cardiac system appear to be normal..
i'm just wondering does she have SLE with Rheumatoid arthritis or is it just one of the manifestation of SLE.
 
i would really appreciaciate if u could giv ur opinion or comments about these case..
 
thank u sir.. maher

Thanks and sorry for the late reply.
Case 1--Interesting to notice how you have thought and tried to correlate the clinical features of the patient to existing patterns of known illnesses. Could you measure her arm span and height. It should be more than the height by around 7 cm. Also we need to look at her upper segment lower segment ratio. One needs to do urine homocysteine to rule out your other suspicion.It will be interesting if we can document a Marfan's with Thallasemia.

Case 2--Her arthritis may be a manifestation of her SLE (However overlap of SLE and RA is known in mixed connective tissue disorders or even otherwise) Rakesh